Reports To: Chief Financial Officer Department: Dental Clinic Position Summary: The Dental Billing and Credentialing Specialist plays a critical role in supporting the dental department’s financial operations and provider enrollment processes. This position ensures accurate and timely submission of dental claims, manages follow-ups and denials, and maintains current provider credentials in compliance with Medicaid, Medicare, and private insurance requirements. Key Responsibilities: Billing and Revenue Cycle Support • Prepare, review, and submit dental claims to insurance carriers via electronic and/or paper submission. • Post insurance payments and patient payments into the system accurately and reconcile accounts. • Monitor outstanding claims and perform timely follow-ups to resolve denials, rejections, and underpayments. • Verify patient insurance eligibility and benefits prior to services. • Generate monthly billing reports and assist with audits or financial reconciliations. • Communicate with dental providers and front desk staff to ensure documentation and billing accuracy. Credentialing and Enrollment • Coordinate initial credentialing and re-credentialing of dental providers with payers (Medicaid, Medicare, commercial insurers). • Maintain up-to-date records of CAQH profiles, NPI registrations, and licensing information. • Track and manage credentialing deadlines and revalidation schedules to ensure no lapse in billing privileges. • Submit provider enrollment applications and respond to payer correspondence as needed. Compliance and Documentation • Ensure compliance with HRSA, state, and payer-specific regulations regarding billing and credentialing. • Maintain accurate and organized records for audits and internal/external reporting. • Stay updated with dental billing codes (CDT), payer policies, and credentialing standards. Qualifications: • High school diploma or equivalent required; associate degree or higher in healthcare administration or related field preferred. • Minimum 2 years of experience in dental billing and credentialing, preferably in an FQHC or community health center setting. • Strong knowledge of CDT codes, insurance billing, and credentialing processes. • Proficiency with dental EHR/PM systems (e.g., Dentrix, Eaglesoft, Open Dental). • Familiarity with Medicaid, Medicare, and managed care plans. • Excellent organizational, communication, and problem-solving skills. • Ability to handle sensitive information with discretion and maintain HIPAA compliance. Preferred: • Experience with HRSA compliance and UDS reporting requirements. • Bilingual (e.g., Spanish, Arabic, Hmong) a plus. • Certified Dental Coder (CDC) or similar credential preferred.